Subfascial
endoscopic perforator surgery (SEPS) is an innovative approach for
treatment of chronic venous insufficiency or leg ulcers. SEPS surgically
addresses the cause of the disease through an approach using 1 to 3 small
incisions.

The
benefits of SEPS may include a higher rate of wound healing and reduced
chance of developing new ulcers -

This brochure is
intended to provide you with a better understanding of SEPS. If you have
questions after reading this booklet, please write them down so that your
doctor or other healthcare professional can answer them for you.

Overview of the Venous System:

The venous
system consists of veins that return blood from the body to the heart.
In the leg, blood normally flows from the superficial veins, which are
near the surface to the perforator veins which

connect to the deep deep
veins. The deep veins return blood top the heart.

There are valves within the
venous system that ensure that blood flows in one direction to the
heart and does not flow backwards.

There is also a muscle of the calf of the lower leg, the "calf muscle
pump," which helps to push the blood up the legs to the heart.

A venous
ulcer is an open sore or wound on the surface of the skin caused by
problems with the veins or venous system. Venous ulcers usually
occur on the inside of the lower leg in the ankle area.

What Causes Venous Ulceration?

A venous ulcer can result when a valve or a calf muscle pump does not
work properly and causes the blood to backflow. This is called
"reflux." Backflow causes increased pressure in the vein and
surrounding tissue. The leg becomes swollen from this increased
pressure.

Also, this pressure causes
skin changes. The skin can become discolored, darker, tight,
shiny and hard.
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If an external injury, bump, or even a slight scratch affects this
damaged tissue, an ulcer can form.

An ulcer is very hard to heal because of the underlying pressure
caused by swelling. Skin changes prevent oxygen and nutrients
from reaching the skin surface to help heal the ulcer.

What Treatments Can Help
Heal My Venous Ulcer?

There are several
non-surgical treatments that can help reduce swelling and heal the
wound including: elevation, leg positioning, stretch wraps,
compression stockings and compression pumps.

However, because these
treatments do not address the underlying disease, many alternatives
must be used every day for an entire lifetime. If proper
treatment is not followed strictly, the ulcer will not heal or new
ulcers may develop. There are also surgical alternatives which
may help heal the wound.

What is SEPS?

SEPS is a minimally invasive
surgical procedure to treat the underlying condition that causes
venous ulcers. During the SEPS procedure, abnormal perforator
veins are disconnected. Abnormal perforator veins have
improperly functioning valves that can cause ulceration. By
disconnecting these abnormal veins, blood flow is redirected to
healthy veins. This improves circulation in the leg and leads to
ulcer healing.

What Are The Benefits of
SEPS?

By addressing the underlying
cause, the SEPS procedure may:

Enable the ulcer to heal in
a relatively short period of time (4 to 8 weeks)

Reduce the chance of
developing new ulcers

What Happens Before
Surgery?

Before the procedure, a
technician may use an ultrasound machine and a marking pen to map on
your leg the location of all the veins that are not working properly.
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Before the procedure begins, you are given general, spinal or local
anesthesia to ensure you will not feel pain during the surgery.
You and your doctor will discuss what is best for you.

What Happens During
Surgery?

In a typical SEPS procedure,
a small incision is made in the inside area of your leg near your
knee.

A special balloon is then
inserted into this incision to reach an area near the perforator
veins. The balloon is then inflated to create a space for the
surgeon to operate.

After the balloon is removed,
a small camera is inserted into the space created by the balloon.
This allows the surgeon to see the perforators inside the leg and
operate through small incisions made in healthy skin away from
ulcerated tissue.

Another small incision is made near the first
incision where other small instruments can be inserted. These
instruments are used to disconnect the perforator veins which art not
functioning in order to route the blood through other veins so the
blood can move freely toward the heart.

Vein stripping is often performed in
combination with SEPS to heal your venous ulcer. If done, the
vein stripping will also be performed at the same time. Your
doctor will discuss this with you prior to surgery.
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When the surgery is complete,
the incisions are closed, a dressing is placed over the incisions, and
a compression wrap is placed on the leg.

What Happens After Surgery?

After surgery, you will rest
in the recovery room until your doctor feels you are well enough to go
home. You may receive medication to relieve any pain you may
have following surgery, although pain is usually minimal. The
surgeon will remove the dressing in 2 to 4 days. You may need to
wear a wrap or compression stocking until healing is complete.
This typically occurs in 4 to 8 weeks.

How Do I Care For The Open
Wound?

The wound must be free of
infection and may require some surgical cleaning and antibiotics.
Your physician or health professional will chose which types of
dressing is best for the wound.